tetano
Editor, Senior Moderator
J Gen Intern Med
. 2020 Jun 30;1-10.
doi: 10.1007/s11606-020-05983-z. Online ahead of print.
Risk Factors for Mortality in Patients With COVID-19 in New York City
Takahisa Mikami[SUP] 1 2 [/SUP], Hirotaka Miyashita[SUP] 1 2 [/SUP], Takayuki Yamada[SUP] 1 2 [/SUP], Matthew Harrington[SUP] 1 2 [/SUP], Daniel Steinberg[SUP] 1 2 [/SUP], Andrew Dunn[SUP] 1 3 [/SUP], Evan Siau[SUP] 4 5 [/SUP]
AffiliationsExpand
Abstract
Background: New York City emerged as an epicenter of the coronavirus disease 2019 (COVID-19) pandemic.
Objective: To describe the clinical characteristics and risk factors associated with mortality in a large patient population in the USA.
Design: Retrospective cohort study.
Participants: 6493 patients who had laboratory-confirmed COVID-19 with clinical outcomes between March 13 and April 17, 2020, who were seen in one of the 8 hospitals and/or over 400 ambulatory practices in the New York City metropolitan area MAIN MEASURES: Clinical characteristics and risk factors associated with in-hospital mortality.
Key results: A total of 858 of 6493 (13.2%) patients in our total cohort died: 52/2785 (1.9%) ambulatory patients and 806/3708 (21.7%) hospitalized patients. Cox proportional hazard regression modeling showed an increased risk of in-hospital mortality associated with age older than 50 years (hazard ratio
2.34, CI 1.47-3.71), systolic blood pressure less than 90 mmHg (HR 1.38, CI 1.06-1.80), a respiratory rate greater than 24 per min (HR 1.43, CI 1.13-1.83), peripheral oxygen saturation less than 92% (HR 2.12, CI 1.56-2.88), estimated glomerular filtration rate less than 60 mL/min/1.73m[SUP]2[/SUP] (HR 1.80, CI 1.60-2.02), IL-6 greater than 100 pg/mL (HR 1.50, CI 1.12-2.03), D-dimer greater than 2 mcg/mL (HR 1.19, CI 1.02-1.39), and troponin greater than 0.03 ng/mL (HR 1.40, CI 1.23-1.62). Decreased risk of in-hospital mortality was associated with female sex (HR 0.84, CI 0.77-0.90), African American race (HR 0.78 CI 0.65-0.95), and hydroxychloroquine use (HR 0.53, CI 0.41-0.67).
Conclusions: Among patients with COVID-19, older age, male sex, hypotension, tachypnea, hypoxia, impaired renal function, elevated D-dimer, and elevated troponin were associated with increased in-hospital mortality and hydroxychloroquine use was associated with decreased in-hospital mortality.
. 2020 Jun 30;1-10.
doi: 10.1007/s11606-020-05983-z. Online ahead of print.
Risk Factors for Mortality in Patients With COVID-19 in New York City
Takahisa Mikami[SUP] 1 2 [/SUP], Hirotaka Miyashita[SUP] 1 2 [/SUP], Takayuki Yamada[SUP] 1 2 [/SUP], Matthew Harrington[SUP] 1 2 [/SUP], Daniel Steinberg[SUP] 1 2 [/SUP], Andrew Dunn[SUP] 1 3 [/SUP], Evan Siau[SUP] 4 5 [/SUP]
AffiliationsExpand
- PMID: 32607928
- PMCID: PMC7325642
- DOI: 10.1007/s11606-020-05983-z
Abstract
Background: New York City emerged as an epicenter of the coronavirus disease 2019 (COVID-19) pandemic.
Objective: To describe the clinical characteristics and risk factors associated with mortality in a large patient population in the USA.
Design: Retrospective cohort study.
Participants: 6493 patients who had laboratory-confirmed COVID-19 with clinical outcomes between March 13 and April 17, 2020, who were seen in one of the 8 hospitals and/or over 400 ambulatory practices in the New York City metropolitan area MAIN MEASURES: Clinical characteristics and risk factors associated with in-hospital mortality.
Key results: A total of 858 of 6493 (13.2%) patients in our total cohort died: 52/2785 (1.9%) ambulatory patients and 806/3708 (21.7%) hospitalized patients. Cox proportional hazard regression modeling showed an increased risk of in-hospital mortality associated with age older than 50 years (hazard ratio
2.34, CI 1.47-3.71), systolic blood pressure less than 90 mmHg (HR 1.38, CI 1.06-1.80), a respiratory rate greater than 24 per min (HR 1.43, CI 1.13-1.83), peripheral oxygen saturation less than 92% (HR 2.12, CI 1.56-2.88), estimated glomerular filtration rate less than 60 mL/min/1.73m[SUP]2[/SUP] (HR 1.80, CI 1.60-2.02), IL-6 greater than 100 pg/mL (HR 1.50, CI 1.12-2.03), D-dimer greater than 2 mcg/mL (HR 1.19, CI 1.02-1.39), and troponin greater than 0.03 ng/mL (HR 1.40, CI 1.23-1.62). Decreased risk of in-hospital mortality was associated with female sex (HR 0.84, CI 0.77-0.90), African American race (HR 0.78 CI 0.65-0.95), and hydroxychloroquine use (HR 0.53, CI 0.41-0.67).
Conclusions: Among patients with COVID-19, older age, male sex, hypotension, tachypnea, hypoxia, impaired renal function, elevated D-dimer, and elevated troponin were associated with increased in-hospital mortality and hydroxychloroquine use was associated with decreased in-hospital mortality.